Care Partners Pt 3: Burden and Help

Last week's blog was about the challenges of care partnering. While there can be blessings which last week's blog also discussed, the challenges can be detrimental to good care and as well as being actually deadly. Even so, if you are like most care partners, you want above all else to provide the best care possible for your loved ones. Thus, you need to stop and look for ways to do this and maintain your own well-being so that you can keep on doing that best job you can.

Care partners often feel that that they don't have the time or the energy or the know-how to do it all or do it right. No wonder they are usually stressed and overburdened! That doesn't have to be. Better information can actually change the workload, but even more importantly, it can change a person's expectations. These two together can change a person's stress level. And when a care partner's stress level is lower, so does their loved one's along with their stress-related behaviors, which decreases the workload.

Well, that's just great, you say. But I know what needs to be done and I know that it takes more time, energy and skill that I often have.

Well, first, let's look at that workload. What doesn't really have to be done? Start prioritizing and do only those things that need doing now. For example, dishes don't need to be done after every meal--or even every day. But there comes a time when you likely will need help. Dementia is an expensive disease. One reason is that extra help often becomes a necessity, not a luxury. If, even after you've done everything you can to cut down your workload, you are still feeling overburdened and stressing out, the time has come to find help.

Admitting your loved one to a care facility is something that most care partners put off until they have no other option. You might want to reconsider for a couple of reasons.

• The earlier a person enters a care facility, the more likely they will be able to become a part of the community and not simply someone sitting alone in their room.
• When someone else provides the physical care that wears you out and keeps you up at night, you can return to being family instead of caregiver. Nancy, a very reluctant care partner who finally made the move reported, "I so wish I'd done this sooner. We've gone back to being husband and wife and I love it." No longer overworked and under-rested, Nancy was able to provide her husband better emotional support, something that only she could do.

If your loved one is still at home and hiring help isn't in the budget, review the budget and see if you can fit it in after all. It is that important. The help doesn't have to be with your loved one to be very helpful. Someone to do household or yard chores can free you up to do the caregiving that you may prefer to do personally.

• Call your local Area Agency on Aging and ask about organizations that can help with the cost or even provide some care. 
• Talk to your church leaders and secular organizations like the Kiwanis and the Elks.
• If your loved one is a vet, contact the VA. Such organizations often have groups that visit and often provide non-nurse-related help such as lawn mowing or vacuuming.
• Finally, let go of your pride and ask family members, friends and neighbors to help. Family might be able to share expenses, or an adult child might be willing to spend nights with your loved one so that you could get needed rest. Friends and neighbors can spend an hour or so with your loved one to give your a break, provide meals or do house-or-yard work.

Once you have more help, you will find that you are doing a better job at those things that only you can do: providing your loved one's emotional support, managing the many aspects of care--doctor's visits, physical therapy, and so on.

Make sure you include some personal time. This is not a luxury. It is what refreshes you and keep you going. It should include not only some time to go to lunch with friends or yes! a support group, but also some quiet time at home for something like reading or a hobby. And don't forget your two-minute breathing breaks. Interrupting a stressful moment for one of these can cut down on a lot of friction!

Next week will be more about where you can get help.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
Responsive Dementia Care: Fewer Behaviors Fewer Drugs
Lewy Body Dementia: A Manual for Staff

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Care Partner Pt 2: Challenges and Blessings

Last week's blog started the year out with a discussion about care partnering and what it involves. This week's blog continues that discussion with a focus on challenges and blessings.

As shown last week, the job itself can involve many aspects, each of which can be challenging physically, mentally and/or emotionally. But other challenges that make a care partner's already difficult job even more difficult include elevated sense of burden and reactions due to changes in their relationship with their loved one that result in stress-related:

• Depression, due to feelings of loss, ineffectiveness, frustration, tiredness, etc.
• Higher risk of heart disease and headaches, due to increased fight and flight hormones.
• Digestive problems, due to stress induced decrease in digestive functioning.
• Disturbed sleep, due to their loved one's interruptive sleep behaviors.

It's no surprise to care partners to read that their job is challenging. They already know this from personal experience. However, there is also scientific proof. We talk a lot about using biomarkers to help diagnose our loved one's diseases, but they can also show evidence of the challenges that care partners face. Biological marker abnormalities among caregivers include:

• Increased cortisol secretion, a stress-related hormone.
• Abnormal glucose regulation, caused by hormones that add energy for a short term flight/fight reflex but tax a body's insulin production when stress is chronic.
• Inflammation, a normal response to foreign bodies, that becomes harmful when stress is chronic.
• Weakened immune system, when a normal decreased immune response is extended by chronic stress.

Even so, care partners find it difficult to seek out the help they need due to being:

• Too overwhelmed. Seeking help may seem like just one more job in an already too full workload.
• Too depressed. Depression can take away a person's ability to initiate...or in this Increased stress reactions associated with altered relationship dynamics, elevated sense of burden and depression
• Too frustrated. Frustration is a negative emotion that motivates action but that action is seldom positive or helpful. More likely it instigates anger which only makes the situation worse.
• Too isolated. It is essential to have open discussions to maintain well-being but dementia care can be quite isolating, as friends fall away and the job becomes to demanding to allow outside interests.

However, dementia care partnering isn't all negative. Care partners can experience a variety of positive feelings and emotions. Many care partners say that even though the job is difficult, it can also be rewarding. Perceived benefits associated with caregiving include:

• The opportunity to give back. Giving is a positive feeling that always helps.
• Improved relationships. As care partner and loved one learn to work closely together, a new and sometimes, better relationship can appear. This relationship will change as the disease degenerates however.
• Feeling good about the quality of care. Most care partners know that they can provide better, more individualized, care for their loved one than a care facility can.
• Serving as a role model for others. This is most likely to happen in a support group and is one of its important values.
• Increased self-esteem, a normal result of feeling useful and needed.
• An enhanced sense of purpose. Care partnering is a demanding job and expending the effort to do it well feels good...as long as it doesn't get so difficult that it becomes burdensome.
• Feelings of pleasure and satisfaction. These can vary greatly, from the pleasure of a job well done to seeing the contentment of one's loved one to being more appreciated of personal time when it occurs.

A good share of the information for this blog came from Dr. James Galvin's presentation at the 2019 International Dementia with Lewy Bodies Conference.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
Responsive Dementia Care: Fewer Behaviors Fewer Drugs
Lewy Body Dementia: A Manual for Staff

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Phrase of the Month: Care Partner

Over the last year we've started using certain words and phrases more and more. One of these is "dementia care partner" vs. "dementia caregiver."

We identify a dementia caregiver as anyone who provides care in some way for a person living with dementia. A dementia care partner is usually someone who lives with the person and is responsible for their whole care. That is they may not provide the care, but they are responsible for making sure it is provided.

While a caregiver may provide only physical care, a care partner's job is much more diverse. The responsibilities of a care partner, also called a family caregiver, include many challenges but also with many blessings. The job can involve any of the following and more:

• The physical, hands-on care of their love one. Helping with dressing, toileting, bathing, eating and all those many daily living activities.
• Care management. Arranging for care and services such as doctor's appointments, lab tests, physical and occupational therapy related to LBD and other medical conditions.
• Assessment of a loved one's condition. Deciding when to call a doctor or ask for other help or guidance.
• Social manager and companion, making sure that their loved one continues to have social contact in ways that are less anxiety producing.
• Legal manager. Making sure all the necessary legal paperwork is in place so that as the disease progresses, transitions or responsibility will be smooth.
• Financial manager. Being responsible for the management of regular income and expenses.
• Housekeeper, cook and dietitian. Making sure the home is safe and clutter-free and the food is not only attractive but brain supportive.

Along with all of these jobs, the care partner also usually has a previous relationship with their loved one: spouse, child, or other relative. Jim's was that of spouse. My loved one and I were sisters. My daughter cares for her mother-in-law.

Each of these relationships started out different and involved a variety of challenges as the disease made the roles change. These transitions can be difficult, as responsibilities once held by the loved one pass by necessity to the care partner--not always willingly on the loved one's part!--and as activities once enjoyed by the two become less enjoyable or even impossible. Next week's blogs will explore some of these challenges and identify some blessings.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
Responsive Dementia Care: Fewer Behaviors Fewer Drugs
Lewy Body Dementia: A Manual for Staff

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

How to Plan and Pay for Your Long-Term Care

This week's blog is by guest writer, Hazel Bridges of AgingWellness.com, a website that "aims to provide health and wellness resources for aging seniors." Do check her website out. It is well worth a review. As usual, I've added a few comments in italics.

No one wants to think about a time in their life when they could lose their independence. However, when you or a loved one has dementia, anticipating and planning for long-term care needs will help you save money and stress in the future. As with many things in life, it's better to be safe than sorry. Plus, having a plan in place will give you immediate peace of mind that you or your loved one will always be well cared for. Here are some practical tips to get you started.

Assessing Your Risk of Requiring Long-Term Care

Is There Illness in Your Family?  Knowing your family history of disease can reveal which illnesses you should be prepared for and what preventative measures you can take now. If you have close relatives with diabetes, heart disease, high blood pressure, osteoporosis, or cancer, your chances of winding up with these issues may be higher than normal. Everyday Health recommends obtaining your family medical history by talking to family members, looking at family documents, and reviewing death certificates. If these diseases run in the family, they can cooccur with cognitive decline, making independent living even more of a challenge.

What Does Your Lifestyle Look Like? The lifestyle choices you make right now will affect your health as you age. One study even found that lifestyle has a greater effect on life expectancy than genetics. For example, people who don’t smoke, keep their cholesterol low, and maintain their fitness in their 50s are more likely to see their 90th birthday. When you move into an assisted living facility, your dementia care experts can help you maintain positive habits that will increase quality of life.

Your Options for Funding Long-Term Care

Long-Term Care Insurance. Traditional long-term care insurance can give you the customizability to choose your amount of coverage and how long it lasts. However, you will never see this money if you don’t end up needing care. On the other hand, many insurance companies offer hybrid life insurance and long-term care policies. This type of policy will help you pay for your long-term care if you need it and will pay out a death benefit to your beneficiary if you don’t. (LTC insurance is something you need to get years before you need it. I did, but now the cost of it has increased so much that I had to decrease its benefits to be able to keep it. Do check out the company's options for things like rate increases.)

Medicare. Medicare helps pay for medical costs for people 65 and over, but it does not cover the majority of custodial long-term care expenses. Many people choose to supplement this coverage with a Medicare Advantage plan. Plans vary state to state, but MA plans generally cover extra expenses like vision, dental, and prescriptions. (While coverage of these extra expenses is very helpful, MA plans usually still do not cover custodial long-term care.)

Your Home’s Equity. A reverse mortgage can help seniors pay for long-term care expenses by using their home’s equity. You can either receive a lump sum of cash immediately or receive monthly payments throughout retirement. Importantly, you still have the right to remain in your house even if you exhaust all of the equity in your home. Most often, the lender recoups their money by selling the property after the last spouse passes away or moves. Keep in mind, a reverse mortgage means that your estate will decrease over time, so you’ll want to think carefully before jumping into this decision. (Also be sure to check out all the ramification and use a reputable company for your reverse mortgage. (While this can be a welcome answer to a difficult problem, there have been issues when an uninformed home owner was encouraged to obtain a less than attractive reverse mortgage. Consider getting a second opinion before making the final decision. You need to know exactly what you are getting into.) 

Another way to pay for long-term care is to sell your home outright and downsize into a smaller space. This can be a viable option, but if you’re considering it, it’s a good idea to get an estimate on your home’s value.

Health Savings Account. A Health Savings Account (HSA) is a good option for people who are covered by a high-deductible health plan. You can make tax-free withdrawals at any time when you use the money to cover medical expenses. You can also use the money for non-medical expenses but you will have to pay income tax on it.

Talking about your plans for long-term care may be an uncomfortable conversation to have with your loved ones, but it's an extremely important one. As many as 52 percent of people will need long-term care at some point in their future. Instead of worrying about what the future holds, be well-prepared so you can you can focus on your health right now! (Hazel is so right! Uncomfortable or not, talking about long-term care and planning for it is super important. Also if you and your loved one talk about this early on, while they can feel as though they have a role in the planning, it will go easier when the time comes to put it into effect--even if they don't remember the conversation.)

References:

history of disease 

family medical history

One study

long-term care insurance

think carefully

get an estimate

Health Savings Account

52 percent of people

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
Responsive Dementia Care: Fewer Behaviors Fewer Drugs
Lewy Body Dementia: A Manual for Staff

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Merry Christmas

We wish you a happy, peaceful and joyful holiday season.

Helen and Jim Whitworth

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
Responsive Dementia Care: Fewer Behaviors Fewer Drugs
Lewy Body Dementia Manual for Staff

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Keeping the Joy

Last week's blog was about inviting peace into your life. This week is about keeping it and adding joy.

• Think positive. This often takes a conscious choice because our natural warning system kicks in quickly with the negatives. Pay attention to these--they will keep coming back if you don't! But then, but you canusually choose to think positively instead.
• Be grateful. Wake up and go to sleep counting your blessings. This causes your body to secrete those wonderful feel good hormones and give you a healthy high. No matter how bad things are, you can likely find something to be grateful for. And, by the way, you don't have to have anything specific! Your body responds to just "feeling grateful" just as it does to feeling grateful about a specific thing.
• Reframe. Don't just be grateful for the obvious things. Reframe your tragedies into blessings as well. For example, when I lost my kneecap in an auto accident, I chose to see my need to exercise to keep the knee moving as something I, a fairly sedentary person, probably wouldn't have done otherwise--and a blessing.
• Forgive. Holding only resentments hurts only you. Blaming helps you avoid painful but necessary choices. (Think: What is it about ME that makes me resent that person?)
• Communicate. Ask, share, don't try to read minds or keep secrets. The more open you are the freer, and less stressful you will feel. (This does not mean that you insist that a loved one share your reality when theirs is different!)
• Accept. Accepting does not mean you have to like the changes that dementia brings. But it does make it possible to move on. Accept those changes and accept your loved one's reality when it is different from yours.
• Be generous. Giving, even if it nothing more than a compliment, feels as good to the giver as it does to the recipient. Give all you can...money, talent, time, words and touch. It all counts!

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
Responsive Dementia Care: Fewer Behaviors Fewer Drugs
Lewy Body Dementia Manual for Staff

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.

Inviting Peace Into Your Life

Tis the season for peace...but any dementia care partner knows how stressful this time of the year can be. Here are some suggestions for keeping the peace in your life:

• Take it easy. You have to do that anyway for your loved one, but slow your own life down all you can. The urge for speed adds adrenalin to your system--and causes you to feel stressed.
• Keep it simple. Again, something you've likely learned to do for your loved one. But it works for you too. Sure you want to decorate, but only do a minimal amount. Sure, you want to bake that special pie or casserole, but don't plan a whole fancy meal. Leave that to someone else...let them take over.
• Use increments. Don't do it all today. Spread your work out and plan to do a little each day, or even each hour. Take time to rest and relax in between.
• But do it. Yes, you want to take your time, but don't put off what needs to be done. Procrastination is a form of denial and denial is actually very stressful to maintain.
• Be early. If you do go somewhere, make it a point to be a little early. The fear of being late adds those stressful hormones into your body.
• Breathe. When you feel stressed, just take a minute or two to breathe. This gives your brain some extra fuel to deal with those stress hormones and give you a moment to relax and consciously let go of the pressure.

Merry Christmas! Happy Holidays.

For more information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia
Responsive Dementia Care: Fewer Behaviors Fewer Drugs
Lewy Body Dementia Manual for Staff

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.